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A non-randomized study in consecutive patients with postcholecystectomy refractory biliary leaks who were managed endoscopically with the use of multiple plastic stents or fully covered self-expandable metal stents (with videos).

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dc.contributor.authorCanena, J
dc.contributor.authorLiberato, M
dc.contributor.authorMeireles, L
dc.contributor.authorMarques, I
dc.contributor.authorRomão, C
dc.contributor.authorCoutinho, AP
dc.contributor.authorNeves, BC
dc.contributor.authorVeiga, PM
dc.date.accessioned2015-06-28T15:42:07Z
dc.date.available2015-06-28T15:42:07Z
dc.date.issued2015
dc.description.abstractBACKGROUND: Endoscopic management of postcholecystectomy biliary leaks is widely accepted as the treatment of choice. However, refractory biliary leaks after a combination of biliary sphincterotomy and the placement of a large-bore (10F) plastic stent can occur, and the optimal rescue endotherapy for this situation is unclear. OBJECTIVE: To compare the clinical effectiveness of the use of a fully covered self-expandable metal stent (FCSEMS) with the placement of multiple plastic stents (MPS) for the treatment of postcholecystectomy refractory biliary leaks. DESIGN: Prospective study. SETTING: Two tertiary-care referral academic centers and one general district hospital. PATIENTS: Forty consecutive patients with refractory biliary leaks who underwent endoscopic management. INTERVENTIONS: Temporary placement of MPS (n = 20) or FCSEMSs (n = 20). MAIN OUTCOME MEASUREMENTS: Clinical outcomes of endotherapy as well as the technical success, adverse events, need for reinterventions, and prognostic factors for clinical success. RESULTS: Endotherapy was possible in all patients. After endotherapy, closure of the leak was accomplished in 13 patients (65%) who received MPS and in 20 patients (100%) who received FCSEMSs (P = .004). The Kaplan-Meier (log-rank) leak-free survival analysis showed a statistically significant difference between the 2 patient populations (χ(2) [1] = 8.30; P < .01) in favor of the FCSEMS group. Use of <3 plastic stents (P = .024), a plastic stent diameter <20F (P = .006), and a high-grade biliary leak (P = .015) were shown to be significant predictors of treatment failure with MPS. The 7 patients in whom placement of MPS failed were retreated with FCSEMSs, resulting in closure of the leaks in all cases. LIMITATIONS: Non-randomized design. CONCLUSION: In our series, the results of the temporary placement of FCSEMSs for postcholecystectomy refractory biliary leaks were superior to those from the use of MPS. A randomized study is needed to confirm our results before further recommendations.por
dc.identifier.citationGastrointest Endosc. 2015 Jul;82(1):70-8.por
dc.identifier.urihttp://hdl.handle.net/10400.26/9075
dc.language.isoengpor
dc.peerreviewedyespor
dc.publisherElsevierpor
dc.subjectBiliary Tract Diseasespor
dc.subjectBiliary Tract Surgical Procedurespor
dc.subjectEndoscopy, Digestive Systempor
dc.subjectStentspor
dc.subjectDoenças Biliarespor
dc.subjectEndoscopía do Sistema Digestivopor
dc.subjectProcedimentos Cirúrgicos do Sistema Biliarpor
dc.titleA non-randomized study in consecutive patients with postcholecystectomy refractory biliary leaks who were managed endoscopically with the use of multiple plastic stents or fully covered self-expandable metal stents (with videos).por
dc.typejournal article
dspace.entity.typePublication
rcaap.rightsopenAccesspor
rcaap.typearticlepor

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